Week 3

Question 1

Describe location and key features of the spinal cord

Answer 1

Base of brain down to the lower back, beginning at foramen magnum, terminating at lower border of L1.

2 enlargements: cervical (C3-T2), lumbar (L3-S3), that innervate the upper and lower limbs respectively.

Situated in the vertebral column.

Nerve fibres serve as primary conduit for transmitting sensory and motor information between brain and the rest of the body.

Spinal cord contains its own meningeal layers.
- dura and arachnoid to 2nd sacral vertebrae
- Pia and cord extend to the L1 and L2 level

Extension of meninges below cord creates CSF filled lumbar cistern: important for LP sampling of CSF

Question 2

Key structures of the spinal cord

Answer 2

Cervical enlargement - nerves of upper extremities

Lumbar enlargement - nerves of lower extremities

Cauda equina - horses tail. Distributes spinal nerves to lower body, controls sensory and motor functions of pelvic organs and lower limbs.

Anterior (ventral) root - contains motor neurons carrying impulses away from spinal cord to muscles and glands, controls movements and secretions

Posterior (dorsal) root - contains sensory neurons that carry impulses from sensory receptors in the body towards the spinal cord.

Mixed spinal nerve - formed by fusion of anterior and posterior roots. Contains both sensory and motor neurons. Facilitates bidirectional communication between CNS and peripheral body structures

Question 3

Grey and white matter in the spinal cord

Answer 3

Grey matter:
- inside ‘butterfly’ of spinal cord
- divided into anterior and posterior columns and horns connected by grey comminsure
- amount of grey matter depends on the amount of muscle innervated at that level. Thus greatest in cervical and lumbar enlargements.

Question 4

What are the white matter columns of the spinal cord

Answer 4

Posterior - sensory only: fine touch, vibration and proprioception.

Lateral - mixed sensory and motor: pain, temperature, voluntary skeletal muscle movement

Anterior - mixed sensory and motor: crude touch, pressure, skeletal muscle of trunk

Question 5

Describe gross anatomy of spinal cord

Answer 5

Dorsal (posterior) horn and columns: region of spinal cord grey matter involved in receiving sensory information from peripheral nerves and transmitting to higher brain centres

Ventral (anterior) horn and columns: area of the spinal cord grey matter responsible for housing motor neurons to send signals to muscles and glands controlling voluntary movements and secretions

Lateral horn and columns: spinal cord grey matter involved in regulating autonomic functions such as HR, BP and digestion

Intermediate zone: area in spinal cord grey matter that integrates sensory and motor information coordinating complex reflexes and modulating sensory information before trasnmitssion to brain

Question 6

What are the 31 pairs of spinal nerves, their location and number of how many pairs.

Answer 6

Cervical nerves: C1-C8, 8 pairs

Thoracic nerves: T1-T12, 12 pairs

Lumbar nerves: L1-L5, 5 pairs

Sacral nerves: S1-S5, 5 pairs

Coccygeal nerves: Co1, 1 pair

Question 7

Explain ascending vs descending tracts of the spinal cord

Answer 7

Ascending = sensory pathways that carry afferent information from peripheral NS to the brain. Relays touch, pain, temp and proprioception.

Descending = motor pathways that transmit efferent signals from brain to spinal cord. Controls voluntary and involuntary movement.

Question 8

Discuss the 4 ascending tracts and their functions

Answer 8

Dorsal column medial leminiscus (DCML) tract:
- posterior column of white matter
- vibration, fine touch and proprioception information
- body to brain

Anterior spinothalamic tract:
- Anterior white matter column in spinal cord
- crude touch and pressure sensory information
- body to brain

Lateral spinothalamic tract:
- lateral white matter column
- pain and temperature sensory info
- body to brain

Spinocerebellar tract:
- proprioceptive information
- from uncles and joints to cerebellum for coordination

Question 9

List the 6 descending tracts and their functions.

Answer 9

Lateral corticospinal - regulates fine voluntary movement of distal limbs

Anterior corticospinal - regulates gross voluntary movement of axial muscles

Vestibulospinal - regulates posture and balance based on vestibular input

Reticulospinal - modulates muscle tone and involuntary reflexes

Rubrospinal - facilitates flexor muscle activity and limb movement coordination

Tectospinal - mediates reflexive head and eye movements in response to visual stimuli

Question 10

Describe the vascular supply of the spinal cord

Answer 10

Network of arteries that run along its length.

Primary arteries are the anterior spinal artery which runs along from of the anterior median fissure and the paired posterior spinal arteries which travel along posterior surface of spinal cord.

Other arteries involved:
- segmental medullary arteries derived from vertebral, intercostal and lumbar arteries and enter through intervertebral foramen and contribute to formation of the anterior and posterior reticular arteries.
- anterior spinal artery receives reinforcement from segmental medullary arteries, including the artery of adamkiewicz, critical in supplying lower thoracic and lumbar regions of the cord

Question 11

Define the term ‘spinal reflex’

Answer 11

An autonomic, involuntary response mediated by the spinal cord (bypasses the brain), in response to a stimulus.

Question 12

Describe the different types of spinal reflexes.
- stretch
- golgi tendon
- crossed extensor
- withdrawal

Answer 12

Stretch = autonomic muscle contraction in response to stretching

Golgi tendon = inhibition of muscle contraction to prevent to prevent excessive tension

Crossed extensor = simultaneous extension of opposite limb to balance withdraw reflex

Withdrawal = rapid withdrawal of a body from a harmful stimulus

Question 13

Explain the stretch reflex in more detail

Answer 13

Monosynaptic reflex that occurs when muscle spindles detect rapid stretch in a muscle, leading to immediate contraction to resist further elongation.

Sensory 1a afferent fibres transmit signal to spinal cord through dorsal root —> synapses directly onto alpha motor neurons —> alpha motor neurons exits via ventral horn triggering contraction of same muscle

This reflex helps maintain muscle tone and posture.

Question 14

Explain the golgi tendon reflex in detail

Answer 14

Polysynaptic inhibitory reflex that prevents excessive muscle tension, protects muscles and tendons from damage.

Golgi tendon organ located at the junction of muscles and tendons, function as mechanoreceptors that detect changes in muscle tension.

Excessive force generated within muscle —> lb afferent fibres from Golgi tendon organs transmit signals —> lb afferent fibres enter dorsal horn —> synapses onto inhibitory interneurons —> suppress activity of alpha motor neurons innervating same muscle —> inhibition leads to muscle relaxation —> reduces tension, prevents injury from overload.

Question 15

Explain how spinal reflexes are modulated and under which circumstances

Answer 15

Can be modulated from various factors such as:
- descending signals from brain
- local interneurons in spinal cord
- sensory feedback

Modulation occurs to adjust reflex response based on context and requirements of situation. E.g. altering strength/timing of reflex.

Circumstances for modulation include:
- pain, emotional state, ongoing motor activity.

Question 16

Label upper myotomes

Answer 16

Upper myotomes:
C2 = look at your shoe (cervical flexion/extension)
C3 = fallen tree (cervical lateral flexion)
C4 = im not sure (shoulder elevation)
C5 = arms out wide (shoulder abduction)
C6 = smell your wrist (wrist extension/elbow flexion)
C7 = no zombies in heaven (wrist flexion/elbow extension)
C8 = you’re doing great (thumb extension/ulnar dev.)
T1 = one and done (finger abduction)

Question 17

Label lower myotomes:

Answer 17

Lower myotomes:
L2 = lifts your shoe (hip flexion)
L3 = extends the knee (knee flexion)
L4 = stops the door (Dorsiflexion)
L5 = the toes divide (big toe extension)
S1 = can lift a ton/stilettos (plantarfelxion)
S2 = comes back to you (knee flexion)

Question 18

Describe divisions of ANS

Answer 18

Sympathetic - fight or flight
Parasympathetic - rest and digest

Question 19

Functions of sympathetic and parasympathetic NS on:
Eye
Heart
GI tract
Bladder
Sweat glands
Blood vessels
Penis

Answer 19

Sympathetic response:
Eye - pupil dilation
Heart - positive ionotropic and chronotropic
GI tract - decreased peristalsis
Bladder - relaxes bladder, constricts internal sphincter
Sweat glands - produce sweating
Blood vessels - vasoconstriction
Penis - ejaculation

Parasympathetic response:
Heart - negative chronotropic effect
Eye - pupillary contracting
GI tract - increased peristalsis
Bladder - contracts bladder wall
Sweat glands - no effect
Blood vessels - no blood vessel
Penis - erection

Question 20

Neurotransmitter receptors of the ANS

Answer 20

Alpha-1 receptors ; sympathetic ; smooth muscle contraction

Beta2, beta3 ; sympathetic ; smooth muscle relaxation

Beta1 ; sympathetic ; cardiac muscle contraction

M1, m2, m3, m4, m5 ; parasympathetic ; act on cardiac muscle, smooth muscle and glands

Question 21

Explain the two chain system

Answer 21

A single preganglionic fibre branches into multiple axon collaterals each are capable of forming synapses with numerous postganglionic neurons.

Branching allows for extensive communication and coordination between preganglionic and post ganglionic neurons.

Results in signals originating from a single preganglionic neuron can influence and regulate activity of multiple post ganglionic neurons simultaneously.

This organisation facilitates the integration of autonomic functions and response throughout body

Question 22

Key structures in the ANS

Answer 22

Pre-ganglionic fibres - nerve fibres originating from CNS and extending toward autonomic ganglia.

Post-ganglionic - neurons located in autonomic ganglia and receive signals from pre-ganglionic fibres. Post ganglionic neurons project target organs.

Paravertebral ganglia - autonomic ganglia situated adjacent to spinal column, forms part of SNS

Splanchic nerve - nerves that relay signals between CNS and the abdominal organs

Pre-vertebral ganglia - autonomic ganglia located anterior to vertebral column, regulate visceral functions

Question 23

Define dysautonomia

Answer 23

Failure of the ANS or imbalance of sympathetic/parasympathetic NS.

Symptoms include:
- fatigue
- labile BP
- Orthostatic hypotension
- increased heart rate variability
- bladder and bowel dysfunction
- sexual dysfunction

Question 24

Outline the central control of the ANS

Answer 24

Primary drivers of the ANS are the hypothalamus, limbic system and short-term brain stem-spinal loops.

Roles in ANS regulation
- limbic system: mediates anticipatory and stress responses
- hypothalamus: mediates hunger, temperature, sex drive, and circadian rhythm.
- short-term spinal loops: rapid reflex arcs mediated mediated by local circuits in the brain stem and spinal cord for quick responses to stimuli

Question 25

Describe the autonomic control of pupil diameter

Answer 25

Coordinated action of SNS and PNS. SNS: contracts the pupillary dilatory muscle (norepinephrine) in response to dim light —> causes pupil dilation PNS: contracts the pupillary sphincter muscle (acetylcholine) in response to bright light —> causes pupil constriction

Question 26

Describe horners syndrome

Answer 26

Neurological condition characterised by combination of symptoms resulting from damage to the sympathetic pathway to the eye. Causes: trauma, tumours, vascular disorders, anything affecting sympathetic nerves Clinical features: - partial ptosis: incomplete drooping of upper eyelid - mitosis: unilateral unexplained constriction of pupil - anhidrosis: loss of hemifacial sweating

Question 27

Describe autonomic control of the urinary bladder

Answer 27

Micturition is a spinal reflex facilitated and inhibited by higher brain centres subject to voluntary facilitation and inhibition. Regulated by detrusor muscles of the bladder wall, as well as the internal and external urethral sphincters. Structures and their roles: - detrusor muscle: smooth muscle layer in wall of urinary bladder responsible for contracting to expel urine. - internal urethral sphincter: smooth muscle ring located at the junction of the bladder and urethra, controlling involuntary passage of urine from bladder into urethra. - external urethral sphincter: striated muscle surrounding urethra, voluntary control, responsible for initiating and regulating flow of urine.

Question 28

Activation of muscles: voiding vs filling

Answer 28

Voiding: Detrusor muscle - contracts (parasympathetic) Internal urethral sphincter - relaxes (reduced sympathetic) External sphincter - relax (somatic) Filling: Detrusor muscle - relaxes (sympathetic) Internal urethral sphincter - contract (sympathetic) External sphincter - contract (somatic)

Question 29

List 12 cranial nerves and if they are sensory, motor or both. Also list their functions

Answer 29

I - olfactory (S) - smell II - optic (S) - visual pathway III - oculomotor (M): eye movement, pupil constriction IV - trochlear (M): eye movement, superior oblique V - trigemental (B): facial sensation VI - abducens (M): eye movement, lateral VII - facial (B): facial expression, taste VIII - vestibulochoclear (S): hearing, balance IX - glossopharengeal (B): taste sensation, swallowing X - vagus (B): parasympathetic control XI - accessory spinal (M): head + shoulder movement XII - hypoglosseal (M): tongue movement

Question 30

Describe the basic pattern of motor, parasympathetic, and sensory innervation by a cranial nerve.

Answer 30

- Cranial nerves typically have mixed pattern of innervation. - motor fibres originate from the brain stem and innervate muscles involved in head, neck movement, facial expression and swallowing - parasympathetic fibres often travel with cranial nerves to innervate glands and regulate visceral functions such as digestion + pupil constriction - sensory fibres convey info from sensory receptors in the head and neck to the brain. - each cranial nerve has a specific distribution of motor, parasympathetic, and sensory fibres enabling it to carry out unique functions in the head and neck.

Question 31

Describe function of the oculomotor, trochelar and abducens nerves

Answer 31

LR6 SO4 AO3 Oculomotor: most eye movement and pupil constriction Trochlear: responsible for downward and inward eye movement Abducens: controls lateral eye movement or turning the eye downwards

Question 32

Describe the course of CN III from brain to the extraocular muscles.

Answer 32

Occulomotor nerve pathway: Occulomotor nucelus —> cavernous sinus —> pupillary sphincter or cilliary muscles or superior orbital fissue. If pupillary sphincter —> pupil constriction If cilliary muscle —> accomodation Superior orbital fissure —> superior rectus or medial rectus or inferior rectus —> extraocular muscles innervated. (AO3)

Question 33

Describe the course of CN IV from brain to the extraocular muscles.

Answer 33

Trochelear nucleus located dorsal midbrain (in pariaqueductal grey matter) —> deccusates in brainstem —> emerges at level of inferior colliculus —> cavernous sinus —> superior orbital fissure —> innervates superior oblique muscle (SO4)

Question 34

Describe the course of CN VI from brain to the extraocular muscles.

Answer 34

Abducens nucleus originates in ventral pons —> emerges from brainstem at pontomedullary junction —> cavernous sinus —> superior orbital fissure —> innervates lateral rectus

Question 35

List all extraocular muscles and their movements

Answer 35

Superior rectus - elevates and adducts Inferior rectus - depresses and adducts Medial rectus - adducts the eye Lateral rectus - abducts the eye Superior oblique - depresses, abducts, and internally rotates the eye. Inferior oblique - elevates, abducts, externally rotates

Question 36

Describe consensual light reflex and how it is altered with palsy of CN II or III

Answer 36

Pupillary response where shining light into one eye causes bother pupils to constrict simultaneously. Light enters one eye —> stimulates ipsilateral optic nerve —> relayed to pretectal nucleus of that side —> relayed to both sides edinger westphal nuclei —> send parasympathetic fibres via CN III —> CN III innervates pupillary sphincter —> bilateral constriction Palsy of CN II in one eye, direct response impaired, consensual also diminished. Palsy of CN III, affected eye will not restrict constrict when light is shone into it and consensual response will be absence.

Question 37

Common causes and clinical presentation of palsy of CNIII, CN IV and CNVI

Answer 37

CN III: Causes - ischaemia, infarction, trauma, compression, infection Clinical - ptosis, down and out gaze, dilated pupil CN IV: Causes - trauma, congenital, ischaemia Clinical - vertical diplopia, especially when looking downward, head tilt from affected side. CN VI: Causes - ischaemia; trauma; raised ICP; infection; tumour - horizontal diplopia, medial deviation of affected eye, reduced abduction of the eye

Question 38

Describe function of the trigeminal nerve

Answer 38

5th cranial - Primary sensory nerve for face 3 branches: - ophthalmic, maxillary, mandibular. Motor function by innervating muscles of mastication: - massater, temporalis, pterygoid muscles Dysfunction can result in: - facial pain - numbness - muscle weakness

Question 39

List divisions of trigeminal nerve and functions

Answer 39

V1 - ophthalmic - sensation to the forehead, upper eyelid, front part of scalp V2 - maxillary - innervates middle part of face, includes cheek, upper lip, side of nose V3 - mandibular - sensation to the lower lip, jaw, part of the ear, also controls the muscles of mastication

Question 40

Outline how sensory information from from the face is transmitted to cerebral cortex

Answer 40

Via the trigeminal nerve —> V1, 2, 3, carry sensory signals from regions of face —> sensory fibres travel to trigeminal ganglion near base of skull (and temples) —> synapse to second order neurons —> continue to spinal trigeminal nucleus in brainstem —> sensory information ascends through brainstem to thalamus where synapses —> to primary somatosensory cortex —> perceived as facial sensation

Question 41

Outline the clinical features of trigeminal neuralgia

Answer 41

- chronic pain condition affecting trigeminal nerve - characterised by sudden, severe and sharp facial pain triggered by mild stimuli e.g. touching, chewing, speaking or even cold air. - can be intense and debilitating - described as electric shock like or stabbing sensations - pain typically one side of face, seconds to minutes, with periods of remission Clinical features: - unilateral pain - brief episodes - fasiculations (in facial muscles) - avoidance (avoiding triggers)

Answer 42

- chronic pain condition affecting trigeminal nerve - characterised by sudden, severe and sharp facial pain triggered by mild stimuli

Question 43

Describe function of the facial nerve and what damage can do

Answer 43

7th cranial nerve Controlling muscles of facial expression Originates from the pons Also carries sensory fibres for taste from the anterior 2/3rds of the tongue and provides parasympathetic innervation to the lacrimal and salivary glands Damage can lead to: - facial weakness/paralysis - altered taste - dryness of eyes and mouth

Question 44

Describe course of the facial nerve pathway

Answer 44

Originates in brainstem —> internal auditory meatus —> facial canal —> geniculate ganglion OR tympanic + mastoid segment —> stylomastoid foramen —> branches into 5 terminal segments to innervate facial muscles

Question 45

Describe the 5 divisions of the facial nerve and the regions they innervate

Answer 45

Temporal: supplies motor fibres to muscles of the forehead and eyebrows allowing elevation and forehead wrinkling Zygomatic: innervates muscles round eye enabling eye closure and squinting Buccal: motor fibres to the muscles of the cheek, contributing to facial expression and smiling Marginal mandibular: motor fibres to the muscles of lower face and jaw including muscles for chewing and lip movement (down like a frown). Cervical branch: allows movement in chin and lower corners of mouth TZBMC = 2 zebras bang my cock

Question 46

Describe the corneal reflex

Question 47

Describe the corneal reflex

Answer 47

AKA blink reflex Protective mechanism Cornea is touched or irritated —> sensory fibres from ophthalmic branch of trigeminal nerve carry stimulus to brainstem —> motor nerve fibres from facial nerve stimulate the orbicularis oculi muscle —> causing rapid blink/closure of eyelids through zygomatic branch.

Question 48

Describe function of the vestibulocochlear nerve and what dysfunction can cause

Answer 48

- 8th cranial nerve - transmitting sensory information related to hearing and balance - 2 branches: cholera (hearing), vestibular (balance and spatial orientation) Cochlea branch - carries auditory signals from cochlea of inner ear to the brainstem where they are processed and perceived as sound. Vestibular branch - transmits information about head position and movement from semicircular canals and otolith organs of inner ear to brainstem, maintaining balance and coordinate eye movements. Dysfunction: hearing loss, vertigo, imbalance, difficulties with spacial orientation

Question 49

Describe course of vestibulocochlear nerve

Answer 49

Originates from sensory receptors in inner ear (including cochlea and vestibular apparatus) —> internal acoustic meatus (one nerve) —> temporal bone —> cerebellopontine angle —> brainstem for processing

Question 50

Discuss how vestibulocochlear nerve palsy may present and possible causes

Answer 50

Clinical features: hearing loss Vertigo (spinning sensation) Imbalance (maintaining stable posture/gait) Tinnitus Dizziness/imbalance Causes: Viral infections Acoustic neuromas Head trauma Vascular disorders

Question 51

Describe the function of the glossopharyngeal nerve

Answer 51

Glossopharyngeal: - sensory and motor - related to throat and tongue - sensory fibres carry taste sensations from posterior one third of the tongue - sensation of the oropharynx and posterior tongue - motor fibres innervate stylopharyngeus muscle assisting in swallowing and elevating pharynx during speech and swallowing - role in regulating blood pressure and monitoring blood gas levels through carotid body and sinus branches

Question 52

Describe the function of the vagus nerve

Answer 52

Vagus nerve: - 10th cranial nerve - vital role in regulating several essential bodily functions - innervates many organs in the thorax and abdomen which includes: heart, lungs, digestive tract, contributing to parasympathetic control - functions include: slowing heart rate, stimulating digestive motility and secretion, regulating involuntary reflexes like swallowing and coughing and influencing mood and immune responses.

Question 53

Describe the course of the glossopharyngeal and vagus nerves

Answer 53

Glossopharengeal: Brainstem (medulla) —> jugular foramen —> oropharynx and tongue Vagus nerve: Brainstem (medulla) —> jugular foramen —> pharynx and larynx —> thorax —> abdomen

Question 54

Discuss how glossopharyngeal and vagus nerve palsy may present

Answer 54

Glossopharyngeal: dysphagia, hyporeflexia (gag), throat pain Vagus: dysphonia, dysphagia, velopharyngeal incompetence

Question 55

Describe function of the accessory and hypoglossal nerves

Answer 55

Accessory: motor that supplies the sternocleidomastoid and trapezius muscles involved in head and neck movements. Originates from brainstem and has cranial and spinal components. Dysfunction - weakness/atrophy of muscles, difficulty w/ head rotation, shoulder elevation and maintaining posture. Hypoglosseal: 12 nerve innervates intrinsic and extrinsic muscles of tongue crucial for movement, speech articulation and swallowing. Dysfunction - tongue weakness, atrophy, deviation of tongue towards affected side during protrusion.

Question 57

Describe course of accessory and hypoglossal nerves

Answer 57

Accessory: foramen magnum —> jugular foramen —> internal and external branches Hypoglossal: Medulla oblongata —> hypoglossal canal —> innervation of tongue muscles

Question 58

Discuss how hypoglossal and accessory nerve palsy may present

Answer 58

Accessory palsy: weakness, shoulder drop, neck pain, winged scapula Hypoglossal: tongue deviation, atrophy of tongue, dysphagia

Question 59

Mechanisms of spinal cord injury

Answer 59

Primary injury - mechanical injury at the time of the event such as shearing, contusion, compression, stretching or laceration. - Haemorrhage can begin in central grey matter and increase in size overtime. Can occupy entire grey matter in an hour Secondary injury - bio mechanical and physiological processes occurring at later time points (minutes to days)

Question 60

Spinal cord injury types

Answer 60

Flexion - car crash; can cause forward dislocation or ruptured posterior ligaments Compression - blunt forces: leads to fractured vertebrae Hyperextension - due to trauma; can lead to ruptured anterior ligaments

Question 61

Identify level of spinal cord injury by clinical presentation

Answer 61

Myotomes are levels that are affected by certain movements; can be used to identify and localise lesions at specific regions along spinal cord. Cervical injuries can lead to tetraplagia Thoracic and lumbar injuries can lead to paraplegia. C1-C4 and/or C5-C7 injuries may be life threatening because diaphragm function may be affected. Lumbar and sacral injuries regain ambulation with minimal support.

Question 62

Describe common spinal cord injury syndromes and their differentiating features

Answer 62

Central cord: causes ischaemia, haemorrhage or necrosis. Corticospinal tracts are spared due to lateral location. Loss of movement in arm/hands. Anterior cord: trauma to the anterior cord or blockage or blood supply to anterior artery; dorsal columns are spared; impairment below site of injury; motor function and pain/temperature sensation are loss. Brown-sequard: hemisectioned or damage exclusively on one lateral sided loss of motor function, proprioception on ipsilateral side; loss of pain, temperature, touch, on contralateral side.

Question 63

Describe autonomic dysregulation that occurs as a result of spinal cord injury

Answer 63

Loss of movement: paralysis or paresis in affected limbs or body regions Loss of sensation: impaired or absent ability to feel temperature and tactile stimuli Exaggerated reflexes: heightened reflex responses due to disrupted neural pathways Loss of bowel or bladder control: incontinence or retention of urine or shit. Changes in sexual function: erectile dysfunction, altered sensation, loss of sexual function due to spina cord injury.

Question 64

Autonomic dysreflexia:

Answer 64

AKA autonomic hyperreflexia Occurs in 50-90% of quadriplegics Stimulation to SNS causes uncompensated cardiovascular response - can lead to profound hypertension, bradycardia, pounding headache, blurred vision, dilation of skin blood vessels, flushing, sweating, congestion and nausea. E.g. stimulus, full bladder, sends message to brain, message doesn’t reach brain due to injury, leads to massive sympathetic response, leads to widespread vasoconstriction, leads to huge hypertension, parasympathetic signal sent out via vagus nerve to counteract BP, reduces HR, results in bradycardia Treatments: remove source of stimulation, sit patient up to reduce BP, pharmacological intervention. If left untreated: intracranial haemorrhage, retinal detachment, seizures, cardiac arrhythmias, death

Question 65

Outline initial assessment and clinical management of spinal cord injury

Answer 65

Primary survey - ABCDE (airway, breathing, circulation, disability, exposure) Secondary survey - comprehensive evaluation for additional injuries after stabilising life threatening. - SAMPLE: signs and symptoms, allergies, medications, previous medical history, last consumption, examination head to toe. C-spine immobilisation: prevent further spinal injury Cannulisation: establish IV access for medication and fluid administration Catheterisation: for urine output and bulbocavernous reflex.

Question 66

Explain basis of spinal cord injury investigations, including neurological tests and imaging

Answer 66

Imaging studies, neurological assessments, electro physiological studies, blood tests. CBE = assess for anaemia, infection, metabolic disturbances, other abnormalities EUC = check kidney function and electrolyte balance LFT = evaluate liver health and function Blood glucose = measure sugar levels to rule out hyperglycaemia or hypoglycaemia MRI spine = visualise soft tissue and spinal cord structures CT brain = detect injuries or abnormalities Cervical spine X-ray = identify fractures or dislocations in cervical spine

Question 67

Discuss role of rehabilitation following spinal cord injury

Answer 67

Multidisciplinary team: Physios - physical rehab, exercises to improve mobility and strength. Occupational therapist - assist in regaining daily living skills and adapting to new abilities Social worker - offer support with emotional, financial and social challenges Speech pathologist - address speech and swallowing difficulties if present Psychologist - mental health support and counselling for emotional well-being Exercise physiologist - design and oversee tailored exercise programs for physical improvement. Nurse - coordinate care, monitor health status, provide medical support in rehab settings.

Question 68

Factors affecting rehabilitation outcomes

Answer 68

Significantly influenced by site and type of spinal injury. Varying approaches to rehab such as restorative strategies to compensatory techniques or efforts focused on minimising complications associated. Intrinsic factors like overal health, age, pre-existing conditions, level of external support can greatly impact success of rehab outcomes.

Question 69

Components of rehabilitation

Answer 69

Pressure care - prevent and manage skin breakdown to avoid pressure sores (with physiological) Range of motion - improve and maintain joint flexibility and movement (with physio) Movement/mobility - with occupational therapist, exercise physiologist, physiotherapist. Leisure training - occupation therapies, exercise physiologist, physiotherapist.